impact of repeated thoracentesis on the outcome of chemical pleurodesis in malignant pleural effusion

ABSTRACT

Repeated thoracentesis may cause pleural inflammation and induce local release of proinfammatory cytokine as tumor necrosis factor-alpha [TNF-alpha] which may subsequently enhance the release of plasminogen activator inhibitor-1 [PAI-1] and lead to fibrin formation in malignant effusion. The presence of fibrin strands after repeated thoracentesis may be of considerable value in predicting the success of subsequent pleurodesis in patients with malignant pleural effusions [MPEs]. So, the aim of this work is to study the impact of repeated thoracentesis on the outcome of chemical pleurodesis in MPE. This is a retrospective study included 116 patients with MPE, they were diagnosed finally by pleural fluid [PF] cytology and/or either computed tomography [CT]-guided biopsy or tissue biopsy [Abram's or thoracoscopic biopsy]. These patients were admitted and subjected to the following a] Pleural tapping and the aspirated fluid was sent for chemical, cytological and bacteriological examinations for determination of the inclusion criteria, [b] Tube thoracostomy insertion, [c] Pleurodesis, and assessment of the response to pleurodesis was done once after 30 days and another after 60 days. Regarding pleurodesis success or failure in this work, there was statistically highly significant decrease in the duration of chest tube before pleurodesis in patients with successful pleurodesis than that in patients with failed one. But, statistically non-significant decrease was observed in the duration of chest tube after pleurodesis in patients with successful pleurodesis than that in patients with failed one. There was statistically significant negative correlation between the number of pleural fluid [PF] aspiration and the duration of chest tube after pleurodesis and statistically nonsignificant negative correlation between the number of PF aspiration and the duration of chest tube before pleurodesis. Also, to predict the success of the pleurodesis, after 30 days of pleurodesis with cut-point of PF aspiration number >7 times, sensitivity and specificity were 75.3% and 65.7% respectively and after 60 days of pleurodesis, also, at cut-point of PF aspiration number >7 times, sensitivity of 80.3% was higher than that after 30 days of pleurodesis and specificity of 64.4% which was near that after 30 days of pleurodesis. Repeated thoracentesis may be of considerable value in predicting the success of subsequent chemical pleurodesis in MPE. Repeated thoracentesis of MPE >7 times has good sensitivity, but low specificity in predicting success of subsequent chemical pleurodesis. Measurement of PF glucose levels and PF cytology provide information about the outcome of chemical pleurodesis in MPE